One woman's quest for better health… living with lymphoedema

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Sharing Karens story and her latest update as to how well she is going with the treatment of the Lymphedema… There was a time when she could not wear compression garments due to the size and shape of her legs… However Karen is now going really well it is so good to see.. Thank you Karen as always for sharing your story.. It shows that there is hope for everyone with Lymphedema. Take care

I am not a person who likes to make absolute statements. I have always believed that what works for one person with lymphedema will not always work with someone else with lymphedema. Every person is unique.

BUT I am now going to say that I now believe that compression garments or wraps is the key to living with lymphedema. I have primary lymphedema and I have lived all of my life with it (well officially the lymphedema didn’t show until puberty) and I have had a lot of lymphedema pain for the last 25 years. In the last few months I was able to have treatment where I was wrapped with Coban wraps and my legs were finally to a shape where I could actually wear compression stockings. WooHoo!!! I have not had lymphedema pain since I started wearing my compression stockings (actually since I started being wrapped with the Coban…

This month, I began a journey that I never thought I was prepared for. Upon realizing that I was in my 30’s and having never really addressed why my legs always looked puffy or swollen, I thought I’d go to the doctor. I didn’t really know where to start, so I went to the foot doctor. As part of their intake session, they took an xray of my foot. When I met with the doctor, he looked at my foot movement, my walk and gait, and range of motion. But he said my bones were fine. Even my foot, which he said was not a “flat foot” but a type of flatter foot, was fine. But he said he thought I had lymphedema because of the swelling and that he’d refer me to a lymphedema specialist. I left with a prescription for low level compression wear and some online resources…

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First Patient Dosed in Secondary Lymphedema Study
Andrew Black
Published Online: Monday, Jul 25, 2016
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Eiger BioPharmceuticals dosed the first patient in the Phase 2 Ultra Study of their drug Ubenimex in patients diagnosed with secondary lymphedema. The Ultra study is designed to assess the effectiveness of ubenimex blocking the production of Leukotriene B4 (LTB4).
Ultra Study
The study will evaluate the effects of ubenimex in patients with secondary lymphedema of the lower limb(s) who are optimized on physical therapies. The Ultra Study is a multi-center, randomized, double-blind, placebo-controlled Phase 2 trial assessing 40 patients that will be randomized to receive either 150 mg of ubenimex or placebo three times a day over 24 weeks.

Leukotriene B4 (LTB4) is a naturally-occurring inflammatory substance known to be elevated in both preclinical models of secondary lymphedema as well as human lymphedema disease. Elevated LTB4 causes tissue inflammation and impaired lymphatic function. Targeted pharmacologic inhibition of LTB4 promotes lymphatic repair and reverses lymphedema disease in treated animals.

Ubenimex is an oral, small-molecule inhibitor of leukotriene A4 hydrolase, which regulates the production of leukotriene B4 (LTB4), an inflammatory mediator implicated in PAH. LTB4 is produced from leukocytes in response to inflammatory mediators and is able to induce the adhesion and activation of leukocytes on the endothelium, allowing them to bind to and cross it into the tissue.

Ubenimex is also currently being evaluated in a Phase 2 study for the treatment of Pulmonary Arterial Hypertension (PAH).
Secondary Lymphedema
Secondary lymphedema usually develops as a result of a lymph vessel blockage or interruption that alters the flow of lymph through the lymphatic system and can develop from an infection, malignancy, surgery, scar tissue formation, trauma, radiation, or other cancer treatment Radiation therapy can damage otherwise healthy lymph nodes and vessels, and can cause scarring of the lymphatic vessels which leads to fibrosis and subsequently diminish lymphatic flow.

Always excited to see any research into treating and curing Lymphedema …

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Sharing this to show the wonderful results of lymphatic lyposuction on a ladies leg… She now has her life back which is a huge bonus and makes it worth while to still have to wear her compression .. Thanks Lisa for sharing this positive outcome …

This was one of the many powerful presentations at the Conference, presented by Louise Koelmeyer of Macquarie University. What made it so powerful was that it was a case study of a patient who had undergone surgery and she and her husband were both there to discuss it with us first hand. So many of the talks at the Conference are reports and statistics, so to be able to interact with an actual “case study” was invaluable.

The patient was 48, had six children and was then diagnosed with a gynaecological cancer, requiring surgery/chemo/radiation. After her treatment she developed lymphoedema in her left leg. She lived “out bush” so getting treatment was difficult but she did manage it fairly regularly but couldn’t attend often enough to control the swelling. She had to give up her work as a teacher as she couldn’t move easily but more importantly her leg…

I’ve just returned from the 11th Australasian Lymphology Association Conference, held in Darwin from 26-28 May, 2016. These conferences are filled with information on the latest research which is always interesting and a bit mind-boggling at times. I was very excited that this year there was a real focus on Lipoedema, a condition I am passionate about. I’ll try and set out as much useable information as I can from two speakers in particular – Dr Ramin Shayan from the University of Melbourne, Australia and Associate Professor Karen Herbst from the University of Arizona, USA. In this post I’ll focus on Dr Herbst.

Firstly, according to Dr Herbst, a few of the symptoms of lipoedema (for more information click here):

fatty enlargement of limbs (firstly legs, arms can develop later)

pain

predominantly women affected, if men then they have low testosterone or liver disease

A few weeks ago someone left me a comment on Twitter after I tweeted about my balance problems. She mentioned Radiation Induced Lumbar Plexopathy, something I never heard of it, so I did some research. From what I read, I could very well have this.

My balance problems became evident after I was weaned off pain meds. Before that my doctors thought I was wobbly because of the heavy-duty pain meds I was taking. But when I was drug-free, they checked me over and all they could tell me was “I don’t know.”

I looked around the Internet to see if I could find out for myself and the only thing I came up with was… maybe the chemotherapy attacked my nervous system. I only had two doses but the first one they gave me was accidently over-dosed, so I figured that’s when the damage was done. Since I found nothing concrete and my doctors didn’t seem interested…

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This is a poster created to find others who may have Radiation Induced Lumbar Plexopathy … Have you had Pelvic Radiation? Are you having difficulty walking? Do you have Peripheral Neuropathy? Do you have Pelvic Radiation Disease Symptoms? You may have RILP

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March is drawing to a close and I would like to take the opportunity to thank everyone for making this the best Lymphedema Awareness month ever. For the first time we had World Lymphedema day, on March 6th, as everyone united to bring awareness to a disease that affects millions but is not well supported or understood.

Both those with Primary and Secondary lymphedema stepped out of their comfort zones to tell their stories. What a variety of personal accounts have been shared across social media. The effect lymphedema has on people’s lives is different for each person. The severity is also different for everyone ranging from one limb to the whole body. Some people get many bouts of cellulitus and infections, others non. In some the swelling is very severe, in others manageable. The one thing that unites all Lymphedema sufferers is the need to care for their limbs 24/7 and the need for better financial, physical and mental support. The burden of care financially should not just fall to the patient, in which case many cannot afford the care that is needed.

By bringing awareness we hope to educate people on the needs of those with Lymphedema. We hope to move governments to introduce legislation to cover more of the costs faced by those with lymphedema. We hope to encourage reasearch into this often misunderstood problem.

Thank you to every single person who has been involved in building awareness of Lymphedema. The story writers, the bloggers, the Facebook pages and groups, those that shared on social media those that liked and read and talked about Lymphedema. Those who ran workshops and groups. To Kathy Bates for stepping out to be our spokes person. Everyone no matter how big or small has led to March 2016 being the best awareness month ever…

Well done all …

Feel free to share with others. It can be distributed via social media, reblogged or added to websites. Please do not change the original content and provide appropriate credit by including the author’s name and a link to this blog.https://lymphnodetransplant.wordpress.com/ Thanks

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This is the best news ever from Dr Marga re Lymph Node Transfer Surgery. At last it is no longer called Experimental and has become excepted surgery for Lymphedema … How exciting … This truly gives HOPE to those with Lymphedema .. This is the post from Lymphedema Lilly and Dr Marga …

This is a link to her FB page .https://www.facebook.com/The-Dr-Marga-Practice-Group-275005705498/VASCULARIZED LYMPH NODE TRANSFER (VLNTx) Means HOPE!
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One of the most disheartening aspects of lymphedema is that it is commonly described as a deforming, progressive and chronic medical condition for which there is NO CURE. Lymphedema sufferers often relate reaching out to health care providers for treatment and meet only with a lack of knowledge of this disorder on the part of nurses, physicians and both occupational and physical therapists. This limited access to quality care or assistance results in chronic anxiety and depression for many as it robs patients of any kind of hope to combat the long-term complications and associated disabilities of this disorder.
Lymphedema Lilly was introduced by Dr. Marga F. Massey to help disseminate the most sophisticated treatment options available for the treatment of lymphedema currently available in the United States. This year is a hallmark as microsurgical lymphatic reconstruction has been accepted by the surgical community as a reproducible, effective and safe means to bring relief to patients suffering upper and lower extremity lymphedema. Major academic institutions have added lymphatic reconstruction to their educational missions for residents and fellows as well as in specialized post-graduate educational symposiums. The American Society of Plastic Surgeons now offers lymphatic reconstruction CME Instructional Courses for experienced Plastic Surgeons to learn more of these reconstructive procedures. The battles with insurance companies for coverage are less frequent. In short, patients now have HOPE as access to health care options is easier and more accepted as the standard of care by the medical community.
VLNTx is the most sophisticated form of microsurgical lymphatic reconstruction available today in the United States. Diseased areas of a patient’s lymphatic system are reconstructed using healthy lymphatic tissue including lymph nodes transferred from a remote location elsewhere in the body. Arterial and Venous blood vessels are reconnected using the intra-operative microscope as a means to ensure survival of the transferred lymph nodes in the zone of prior injury, hence the title “Vacularized”. All of Dr. Marga’s patients are enrolled in the oldest American prospective clinical trial addressing VLNTx for treatment of extremity lymphedema to ensure validation of the technique and to track long-term complications. Dr. Marga has more than 10 years of clinical experience in the field and is a Certified Lymphedema Therapist offering care for patients in 5 Centers throughout the US.
Lymphedema Lilly Trivia: It’s rumored that Lymphedema Lilly’s eyes and smile were designed with an attempt to artistically emulate Dr. Marga’s loving approach to being Happy while living with Lymphedema.
Till Next Time, Be Health and Happy!” Dr Marga Massey

Thank you to Dr Marga and all the other surgeons who have worked so hard to have this surgery excepted. Three years ago I was the first person in Australia to have this surgery for my lymphedema leg. I started this blog as there was so little information and non at all from patients. In the last three years I have watched as things have changed, as surgery has improved, as insurance companies do not call it experimental….. All those who have Lymphedema now can have HOPE … One day there maybe a total cure… One thing is certain we are moving towards the light at the end if a very dark tunnel … Helen

Feel free to share with others. It can be distributed via social media, reblogged or added to websites. Please do not change the original content and provide appropriate credit by including the author’s name and a link to this blog.https://lymphnodetransplant.wordpress.com/ Thanks

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In Part Two Loretta tells of her time in Hospital for a Lymph Node Transfer. It did not all run smoothly but she is home and healing well now.

The unwelcome guest Part two

“In 2013 my cancer surgeon encouraged me to speak to a Plastic surgeon that was operating on people with lymphedema. I went for a consult and he said he would take lymph nodes from my neck and put them in to my ankle. I asked him how do I know I won’t get lymphedema in my neck and he said there was a chance!!! I was not happy with this answer and never went back!!! Then in June my surgeon told me about a Dr. at Sloane Kettering who was doing something new with lymphedema patients. I went to see Dr Dayan in July, he told me about the testing he did called Reverse lymph Node Mapping using lymphoscintigraphy. This new test could prevent possible Lymphedema at the donor site, by choosing nodes in areas where they are plentiful. It is also used to check where nodes need to be transferred, to improve the lymphatics. Dr. Dayan is probably the nicest individual I have ever met, he takes the time to speak with you and your family and answer all your questions. I actually went to see him twice before I made my decision. I also asked to speak to a patient that he operated on to see what they had to say. I finally I had the surgery on January 26th 2016 so I am just now recovering.

On the morning of the surgery I had lymphoscintigraphy done on my arms to choose the best nodes to use for the donor site. Dr. Dayan decided to take lymph nodes located under my right arm which were draining into my trunk. I just want to add the lymphoscintigraphy is not something to be afraid of as I had it done three times, twice in my hands and another in my hands and feet. I opted for the lidocaine injections first and all you feel is a pinch then the dye is injected and you do not feel it.

After the surgery Dr Dayan was happy with how it had gone but he told me in order to get the donor nodes they had to cut a nerve and then he sewed it together.The day after surgery the PT tried to get me out of bed but my BP dropped 50 points and I felt so sick. So they asked me to sit on the side of the bed while they remade it. Then the PN emptied my drains. She pulled on the tubing, as they all did, but very close to the donor site, instantly I was in agonising pain. My medical team was there and they tried various pain medications, thank goodness after about two hours the pain subsided. My doctor came and started me on a different medication, for nerve pain, that kept the pain controlled. He did say it could take a couple of months before it totally settled. I also got an infection at the site of the transferred nodes in my calf, so I had to start IV antibiotics. This was a worry incase this damaged the donated nodes. It took a few days to be able to get out of bed due to my blood pressure dropping but gradually I was able to manage. Those first days I felt disappointed in my self for not managing better but I forgot that this is major surgery and it effects everyone differently. I did not want to go home till I could walk and manage ok.

When I had my ovarian cancer surgery I got out of recovery at 2 am the surgeon asked my husband did he think I wanted to go home? How crazy is that they sent me home 10am that morning and later that day I was back in the ER. So this time I was in no hurry to go home.
In the US the insurance companies want you out right away, that is why I was surprised they were even paying for my surgery. Before I could go home the nurse taught me How to give myself an injection of a blood thinner, I think it is lavolax but not sure as was too nervous following instructions to see the name!!! I had to give myself injections for 30 days post surgery!!

As I started to feel better I sat on the edge of the bed good leg dangling lymph leg tucked on bed to get acclimatised to getting up. The nurse and my husband got me to stand up and then sit in a chair. I still got nauseous so they gave me Zofran to take away the nausea. About 20 minutes later the PT came and I got up and I walked/hopped about 10 feet to the hall, sat for a few minutes then walked/hopped back to my chair where I sat for 4 1/2 hours. I felt proud, it felt so good to be out of bed. My doctor came and told me I would not be going home till after the weekend but the next day they will take out the foley catheter I was happy about this but a little scared that I would have to get up and leave myself enough time to get to bathroom…… Hopefully sharing my progress report will help others.

Eventually I got home and felt so happy to be there, I love it. I still had both drains and they would be taken out on Wednesday 2/10. I had the option of going into the Dr earlier to take out leg drain but arm drain was still producing too much? It was not worth it for me to go into NYC for one drain. I live in NJ about a 45 minute ride but I could not get to the car as my garage is down fifteen stairs and four front steps. When I came home from the hospital my husband parked in the driveway and our local rescue squad sent 2 EMT’s . They put me in a chair and carried me up and into my bedroom. So if I went into the city for one drain I would have to get the rescue squad to come twice, so it was best to wait and get two done together.

I am now walking on my leg but I am not 100% yet, still some pain and a lot of stiffness in the calf which is the site of the transferred nodes. I stopped bandaging because too much compression is not my friend it actually causes more swelling. My foot was so swollen but since I stopped bandaging it has gone back to normal. I still wear toe caps on it and have started to wear my ready wrap again with some cotton padding over the transplant site. This has only been for 2 days, I checked with doctor and therapist first and showed the difference in my foot and the improvement since I stopped bandaging. I also stopped with any compression at night. I kept waking up in pain because my foot and ankle was hurting so much and would have to take off whatever I was using for compression, I even tried my Tribute and that was too much as well. So now I happily sleep without anything but elevated my legs ( I have a bed that raises the foot and head) and have seen the swelling in my calf getting better as well as my thigh. My doctor tells me to be patient it could take up to a year or more to see any results. So time will tell, hopefully when I am at my optimum size I will be fitted with a custom stocking:)

I am happy for anyone to ask me questions and I have told Helen to share my email with people. Just send your questions as a comment and I will answer.” Loretta

Thanks once again Loretta for sharing your progress. We can never forget that this is major surgery and sometimes things do not run smoothly as Loretta found. However all those problems are now resolved and it is time to heal and have much patience…

Any information included in this blog does not replace the advice of your Lymphedema Doctor or therapist…. Helen

Feel free to share with others. It can be distributed via social media, reblogged or added to websites. Please do not change the original content and provide appropriate credit by including the author’s name and a link to this blog.https://lymphnodetransplant.wordpress.com/ Thanks

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Lymphoedema Awareness

I am writing this blog to keep a record of my Lymph Node Transplant in the hope of inspiring and helping others.
I wish to bring awareness to the issues of Lymphoedema so that people will better understand this very difficult and little understood health problem. We need more research and a brighter outlook for those with both Secondary and Primary Lymphoedema.
Items in this blog are to only be used in conjunction with a medical diagnosis and with a treatment plan specific to your needs. Please check with your lymphoedems specialist if you are feeling unwell or unsure about treatment and care.. MLD should never be used if you have an infection..Please share this blog with your friends and family... Thanks

Feel free to share with others.. it can be distributed via social media, reblogged or added to websites.. please do not change the original content and provide appropriate credit by including the author’s name and a link to this blog
https://lymphnodetransplant.wordpress.com/ Thanks